Esophageal Trauma

Esophageal trauma may occur concomitant with tracheobronchial injury. This typically manifests several days after the tracheobronchial injury from necrosis of the anterior portion ofthe esophageal wall resulting in a traumatic tracheoesophageal fistula from blunt trauma. Esophageal trauma, however, is most commonly caused by penetrating trauma. Usually this is the result of a transmediastinal gunshot wound and may be difficult to diagnose. The overall management of transmediastinal gunshot wounds will be reviewed; however, after major vascular injuries have been ruled out, the patient should undergo rigid esophagoscopy followed by a Gastrografin swallow. If one is still suspicious after a negative Gastrografin swallow, then a barium swallow should be done. If an esophageal injury is missed, this can lead to lethal consequences from empyema. Management of an esophageal injury is early thoracotomy and primary repair of the injury with placement of a pleural flap over the injury. For the lower portion of the esophagus, exposure is through the left chest. For the mid-esophagus (i.e. upper thoracic esophagus) a right thoracotomy is done.

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